06040066 CITY OF CUPERTINO
BUILDING DIVISICN PERMIT �ACONTRACT6rRI1�;, ORMATION
BUILDING ADDRESS: PERMIT NO.06040066
20085 STEVENS CREEK BLVD
OWNER'S NAME: PERMR LSSOB DATE
FRANK BILBAO 04 /12 /2006
NE:
SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
ioo LICENSED CONTRACTOR'S DECLARATION lob Description
I hereby ATOM that 1 am licensed under provisions of Chapter 9(commencing NP
with Section 10)an 70of Division 3 of Me,Business and Pmicuuioas Code.and my]it.is
± „ in full force and effect. 8��53% FEES FOR REACTIVATING 05070046
a 4 Z License Class
i Fn
Dale Ti.^y Corusemr
ARCHITECTS DECLARATION
f I understand Any plans shall he used As public recorM
>yU
O Licensed Professional
La Oe,I am cop(FILfrom
DECLARATION
f 1 hereby alum on 1 1. exempt from tiro Cosies Cook:
:Any C Law for Ne
5 O o following arson. ermit 171.IS.Business and ve limon Cole:Any city or county
m which leyuilea a permit to cnntruct alar,improv,dcmalicM1.ar¢pair aY swnum $3000
-26 prior m its issuance.also ugUjMS that appliCLll for each permit to file a signed suNmenl
Mat W u licensed pursuant o the provisions,of the Contractor's License Law(Chaptcr9 Sq.Ft. Floor Area Valuation
'Hn (commencing with Section 7")of Division 3 of MC Business and Prefasiom Cum)or
_ NL k is eaempt tharcfmm and the basis for the alleged exemption.Any violation of
Sema.7031.5 by arty,applicant for a permit subjects the applicant in a civil penally of APN Number Occupancy Type
not mmrc than BW handled dollars(s505). P Y YP
L asowocr of Me popery,army empluyca with wages As their solecompewtion,
will do Newark.and Meswmum isnoUnonded In.litnd forabo(S=.7044,Buvvas Required Inspections
and Profession Code:The Committees Liaise Law does not apply m an owner of q P
property who buildsarimproves thereon,and who doessuch work himselfor through his
awn amploY.,Provided NL such improvements arc not intended oraBesed far ale.If.
however,Me building or impmvement is sold within on yea of completion.Me owAL
builder will haw rhe burden of Moving Mat he did not build or improve for purpose of
ark.).
❑1,as owner a(do propeny,am uclusivcly conuating with Banal rnngaztors m
convect Me project(Sec.70",Business and Profession Cade:)The ContracoYs U. ,
asve law does root apply on an owner of property who Wilds or improve Mertoa.and
who conu esu for such projects with a ronvacror(s)licensed for sant o the Conuactoes
License law.
❑I am exempt undo See ,B k P C for this won
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby ani¢under penalty of perjury arc of the following dalaruion:
T haw and will mainuina CenifiateofCmnent toself-inure far Wor ea Camara.
anion,as provided for by Sccumn 3700 of Me Labor Code.far the performance of Me
wade for whim this permit u Issued.
❑1 haw and will maintain Woreer's Compensation Inwnrce,as required by Scmian
3700 of Me labor Cane.for Me Performance ofdne work for which Mu Permit is issued. '
My Worker's Compcnsauon low ce ariar and Policy num W,art:
Camcr. 5 Policy No.:
RTIFlCATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu section need not he complcmd iL Ne permit is Trocars hundred dollars(gI00)
A,less)
1 ccsufy that in the perrmramcc of Me work for which this permit s issued.l shall rat
employ any pecan ire any ma urwu W�om£auu)en a the Worker'Compensation
Laws of CalifmmiaCH"� C-vJ,�_
NOTIAppliCE
artt
NOTICE TO APPLICANT.If.atommaking his Cerinso M Labor Code,YOU
.J Obaome comp y it Wodkal Compensation this provisions of Mc Leel r Code,you must
foMwith eamP1Y wind such provirian or Mu permit dull W deemed rtwked.
CONSTRUCTION LENDING AGENCY
.�
[� I hereby Norm that Mete u s ed(Sec. ending agency for Nc perfocmacce of
Lia Le work for which this permit is issued(Sec.l09'f,Civ.C.)
W C7 lender's Name
7 z Unde'sAdd=
U O 1 certify Met I haw read this application and sum ML Lou stow infmmadom is
U.F correct.l agree o comply with all city and county on inaces and state laws relating to
O U building construction,and hereby antenna,upae nmiva ofthis city in enter upon the
CL7 ahovomer ioned property for inspection purposes.
(, gy (we)agree to ave,indemnify and keep harmless the City of Cupertino against
Z liabilities.ence o Mejoining
oin and of thisuawbich mess in any wyattroc againtsad City
(„)x A APPLICANT
of the RSTA got Mu permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURC� �EGULATIO
/1'12 Re-roofs
SignatureofApplic ons, Data �h _
HAzARObUs MATERIALS DISCLOSURE Type of Roof
Will y L applicant or forum building lCaapat vert or handle Health
ndSafety material
As defined by the Cupertino Municipal Code.Chapter 9.13,and the HnIM and Safety
cads.Salon 25532p)7 All roofs shall be inspected prior to an roofing material beim installed.
❑Yea GgNa P P � Y g g
If a roof is installed without first obtaining an inspection,I
WILL rhe applicant or future building occupant tax equipment or xvien which Qv Pe agree to remove
emir harardnn air contaminants As defined by the Bay Area Air Quality Management all new materials for inspection.
Manic"
0Ya (3Au
I have real Me materials lequimmema under Chapler6.95 ofthe Califor,
ria Health d:SeNty Coda,Secumu 25505,x5533 aWx5531.1 understand thaifthc Wilding
Jon nwI currently have a lemanl ML it is my rnN anibility to nodfy Me occupant of the
oyuirements whir be mm priormissuancc ati(Amer of Occupancy. Signature0 Pllcant Date
Owner or surhori'raJ agevs!/ Dale All roof coverings to be Class "B" or better
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . .
DATE ISSUED. . . . . . . : 04/12/2006
RECEIPT # . . . . . . . . . 33963
REFERENCE ID # • • • : 06040066
SITE ADDRESS . . . . . : 20085 STEVENS CREEK BLVD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : FRANK BILBAO
ADDRESS . . . . . . . . . . : 20085 STEVENS CREEK BLVD
CITY/STATE/ZIP . . . : CUPERTINO,
RECEIVED FROM . . . . : JON LYSONS
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
•FEE ID UNIT , QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 3 , 000 . 00 42 . 00 0 . 00 42 . 00 0 . 00
TOTAL PERMIT 42 00 0 . 00 42 . 00 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 42 . 00 VISA
TOTAL RECEIPT 42 . 00
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